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Time to focus on antimicrobial resistance

The Pan Celtic Dublin 2016 meeting, where the clinical microbiology ‘families’ of Scotland, Wales, Northern Ireland and the Republic of Ireland take it in turn to host a joint event, took place in Dublin recently. The theme of the meeting was ‘Antimicrobial resistance: global threats and challenges in diagnosis, treatment and prevention’ and it painted a worrying picture of the situation both nationally and internationally.

Antimicrobial resistance is a present risk in acute and community services, which microbiologists point out must be managed in a multidisciplinary way. The loss of effective and readily-available treatment options may lead to a future which resembles the ‘pre-antibiotic era’, with increased morbidity and mortality from common infections and while it is easy to see this as a problem that international health bodies will fix, it is an issue that is far closer to home than we care to admit.

In Ireland currently, a major CRE outbreak is ongoing in Tallaght Hospital, Dublin, and the mid west region also has an ongoing CRE outbreak since 2011.

In gonorrhea, the emergence of decreased susceptibility and resistance to the ‘last-line’ antibiotics is cause for international concern, while the continuing high incidence rate in Ireland has also been highlighted. The Pan Celtic meeting’s keynote speaker, Prof Magnus Unemo from the World Health Organisation, spoke strongly on the need for firm action on this disease. He told this newspaper that a future vaccination programme might be the only “feasible solution” to the global rise in gonorrhea, and potentially for other infectious diseases. TB drug resistance is also a growing major challenge internationally.

In Ireland, it is well known our outdated hospital facilities, with large wards and excessively high bed occupancy rates, are key factors that negatively impact infection control. The persistent overcrowding problems in our emergency departments are also a key challenge in this regard, not to mention their impact on patient comfort and dignity.

The new National Children’s Hospital, as well as the ‘planned’ new maternity hospitals, will have single en-suite rooms which are ideal for infection control, but there appears to be little appetite to invest in other hospitals. The capital budget of the HSE has remained statically inadequate in recent years, with only the most urgent projects getting the go-ahead.

However, HSE Director General Mr O’Brien told the Pan Celtic meeting that the challenge of antimicrobial resistance is one reason “why an increase in our capital budget is one of the things I will be arguing for strongly when the National Capital Mid-Term review arises next year”. He said that he “will probably be able to use some of the things discussed at this conference as part of my tool kit” as part of these review discussions.

There have been positive improvements in MRSA rates in Ireland in the last decade, it has to be said, with improved hospital and hand-hygiene initiatives making progress, though variability exists and a consistent focus is key to maintaining and improving progress. Likewise, consistent antimicrobial stewardship is vital and must promote prudent antimicrobial use among all prescribers.

In addition, laboratory diagnosis of multi-drug resistant organisms can be complex, requiring a high level of specialist scientific expertise. Nationally, access to reference laboratories for confirmation of the diagnosis and typing is important, as is improved staffing levels and adequate equipment and laboratory facilities.

As the Pan Celtic Dublin meeting emphasised, antimicrobial resistance is a very significant and important issue for the Irish health service and must be tackled aggressively or we risk enormous and long-term adverse outcomes — including limited and costly antibiotic treatment options, insufficient isolation rooms for affected patients, impact on the diagnostic laboratory services, additional cleaning services and a negative impact on provision of routine and elective healthcare services.

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